Coronary Ligaments Injection

Ligamentous sprain

Causes and findings:
• Trauma - a strong forced rotation of the knee with or without meniscal tear
• Pain usually at medial joint line
• Painful: passive lateral rotation possibly meniscal tests

Equipment:
Syringe - 1ml
Needle - 25G 0.5 inches (16mm) orange
Kenalog 40 - 10 mg
Lidocaine - 0.75 ml 2%
Total volume - 1 ml

Anatomy:
The coronary ligaments are small thin fibrous bands attaching the menisci to the tibial plateaux. The medial ligament is more usually affected. It can be found by placing the foot on the table with the knee at right angles and turning the foot into lateral rotation. This brings the tibial plateau into prominence and the tender
area is sought by pressing in and down onto the plateau.

Technique:
• Patient sits with knee at right angle and planted foot laterally rotated
• Identify and mark tender area on tibial plateau
• Insert needle vertically down onto plateau
• Pepper all along tender area

Aftercare:
Early mobilizing exercise to full range of motion without pain is started immediately.

Comments:
This lesion is commonly misdiagnosed; apparent meniscal tears, anterior cruciate sprain and patellofemoral joint lesions might be simple coronary ligament sprains.

Alternative approaches:
These ligaments usually respond extremely well to deep friction massage - it is not uncommon to cure the symptoms in one session. The injection should be kept for where the friction treatment is not available or where the pain is too intense to allow the pressure of the finger. Tear or subluxation of the meniscus should be treated first by manipulation.